DESCRIPTION (provided by applicant): The primary focus of this proposed study is to consider the potential unintended consequences of tobacco denormalization strategies for LGBT adults. In particular, we will examine the processes of stigmatization as they relate to tobacco denormalization, tobacco use, and sexual and gender identities. This project expands our research portfolio on tobacco-related stigma. Currently we are funded to examine perceptions of tobacco denormalization among African American young adults in California. We will address the following aims: 1. Understand perceptions of tobacco denormalization strategies and related beliefs and attitudes about the stigmatization of tobacco among LGBT smokers and former smokers in California; 2. Examine the ways in which the stigmatization of tobacco use may intersect with sexual and gender identity stigmas; 3. Explore alternative strategies that may be more effective in reducing the prevalence of smoking among LGBT adults in California. This study includes 2 phases. In Phase 1, we will conduct asynchronous online group interviews in 10 forums where LGBT adults meet and engage online. Phase 2 will consist of 240 in-depth qualitative interviews conducted with LGBT adults who live in California. The sample will be stratified by sexual/gender identity status, smoking status (current smoker/former smoker), and age (young adults/adults) with 15 participants included in each cell. Complementing online group interviews with in-person individual interviews will help to reveal group norms and beliefs as well as the plurality of beliefs within the group to yield a more holistic understanding of study aims. Using a pattern-level approach to the analysis of the narrative data from phases 1 and 2, we will investigate the processes of tobacco-related stigmatization and its relationship to tobacco denormalization for LGBT adults, as well as how the overlapping stigmas of other social identities may shape the experience of tobacco-related stigma for LGBT adults. Results from the study will be disseminated through traditional conference presentations and academic journal publications, as well as through a project website that includes an accessible presentation of study findings and a social media forum to solicit feedback from study participants and people concerned about the high prevalence of smoking among LGBT adults. This application has important implications for developing an alternative and more equitable tobacco prevention strategy that minimizes rather than exacerbates health inequities for LGBT adults. Moreover, this project is situated within a broader public health framework that investigates reasons for unresponsiveness and/or resistance to social norming policies among marginalized minority groups. Findings from this study may have important implications for other types of public health policies as well as implications for researching the persistence of smoking among other minority groups.
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